Membership Renewal Questionnaire - 2009/2010

 

Please fill out the following Membership Survey Questionnaire, Fiscal Year 2009/2010.
The form requires a response to all questions.
When the Questionnaire is complete, click the "Submit" button at the bottom of the page to send the completed Questionnaire to GPA.

Thank  you.

First Name *

Last Name *

Email *
Phone Number *
1. Are you presently enrolled in an accredited psychology program? *
2. Have you received your doctoral degree in psychology within the last year? *
3. Have you received your doctoral degree in psychology within the last 2 years? *
4. Are you presently licensed by the Georgia Board of Examiners of Psychologists? *
5. Do you derive any portion of your annual taxable income from fee-for-service practice? *
6. Are you presently licensed in the State of Georgia as a mental health provider other than as a psychologist? *
7. Are you neither a psychologist or other mental health provider, but work within a related profession with an interest in psychology? *
8. Have you served GPA in the volunteer leadership position of President? *
9. Are you presently 65 years or older AND fully retired? *
10. Do you currently find yourself in a situation of undue hardship that prevents you from renewing as a GPA member? *




 

Georgia Psychological Association  
2200 Century Parkway, Suite 660 
Atlanta, Georgia 30345
Phone: 404-634-6272  Fax: 404-634-8230
Contact Staff    
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American Psychological Association